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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2024

Open Access 26-12-2023 | Gastrectomy | Guidelines

An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer

Authors: Amila Cizmic, Ivan Romic, Andrea Balla, Nicolò Barabino, Gabriele Anania, Gian Luca Baiocchi, Branko Bakula, Carmen Balagué, Felix Berlth, Vasile Bintintan, Umberto Bracale, Jan-Hendrik Egberts, Hans F. Fuchs, Suzanne S. Gisbertz, Ines Gockel, Peter Grimminger, Richard van Hillegersberg, Noriyuki Inaki, Arul Immanuel, Daniel Korr, Philipp Lingohr, Pietro Mascagni, Nathaniel Melling, Marco Milone, Yoav Mintz, Salvador Morales-Conde, Yusef Moulla, Beat P. Müller-Stich, Kiyokazu Nakajima, Magnus Nilsson, Matthias Reeh, Pierpaolo Sileri, Eduardo M. Targarona, Yuki Ushimaru, Young-Woo Kim, Sheraz Markar, Felix Nickel, Anuja T. Mitra

Published in: Surgical Endoscopy | Issue 2/2024

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Abstract

Background

Minimally invasive total gastrectomy (MITG) is a mainstay for curative treatment of patients with gastric cancer. To define and standardize optimal surgical techniques and further improve clinical outcomes through the enhanced MITG surgical quality, there must be consensus on the key technical steps of lymphadenectomy and anastomosis creation, which is currently lacking. This study aimed to determine an expert consensus from an international panel regarding the technical aspects of the performance of MITG for oncological indications using the Delphi method.

Methods

A 100-point scoping survey was created based on the deconstruction of MITG into its key technical steps through local and international expert opinion and literature evidence. An international expert panel comprising upper gastrointestinal and general surgeons participated in multiple rounds of a Delphi consensus. The panelists voted on the issues concerning importance, difficulty, or agreement using an online questionnaire. A priori consensus standard was set at > 80% for agreement to a statement. Internal consistency and reliability were evaluated using Cronbach's α.

Results

Thirty expert upper gastrointestinal and general surgeons participated in three online Delphi rounds, generating a final consensus of 41 statements regarding MITG for gastric cancer. The consensus was gained from 22, 12, and 7 questions from Delphi rounds 1, 2, and 3, which were rephrased into the 41 statetments respectively. For lymphadenectomy and aspects of anastomosis creation, Cronbach’s α for round 1 was 0.896 and 0.886, and for round 2 was 0.848 and 0.779, regarding difficulty or importance.

Conclusions

The Delphi consensus defined 41 steps as crucial for performing a high-quality MITG for oncological indications based on the standards of an international panel. The results of this consensus provide a platform for creating and validating surgical quality assessment tools designed to improve clinical outcomes and standardize surgical quality in MITG.
Appendix
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Metadata
Title
An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer
Authors
Amila Cizmic
Ivan Romic
Andrea Balla
Nicolò Barabino
Gabriele Anania
Gian Luca Baiocchi
Branko Bakula
Carmen Balagué
Felix Berlth
Vasile Bintintan
Umberto Bracale
Jan-Hendrik Egberts
Hans F. Fuchs
Suzanne S. Gisbertz
Ines Gockel
Peter Grimminger
Richard van Hillegersberg
Noriyuki Inaki
Arul Immanuel
Daniel Korr
Philipp Lingohr
Pietro Mascagni
Nathaniel Melling
Marco Milone
Yoav Mintz
Salvador Morales-Conde
Yusef Moulla
Beat P. Müller-Stich
Kiyokazu Nakajima
Magnus Nilsson
Matthias Reeh
Pierpaolo Sileri
Eduardo M. Targarona
Yuki Ushimaru
Young-Woo Kim
Sheraz Markar
Felix Nickel
Anuja T. Mitra
Publication date
26-12-2023
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-023-10614-9

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